Provider Demographics
NPI:1306472105
Name:RIDEAUX, SEVEN
Entity type:Individual
Prefix:
First Name:SEVEN
Middle Name:
Last Name:RIDEAUX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BRIAN
Other - Middle Name:
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2900 OAK TREE AVE APT 2204-A
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-8217
Mailing Address - Country:US
Mailing Address - Phone:405-541-1854
Mailing Address - Fax:
Practice Address - Street 1:2900 OAK TREE AVE APT 2204-A
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-8217
Practice Address - Country:US
Practice Address - Phone:405-541-1854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-12
Last Update Date:2020-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator